Diagnosis and Management of the Spine and Lower Extremity in Orthopedics

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 July 2023) | Viewed by 7598

Special Issue Editor

Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
Interests: spine; hip; pelvis; lower extremity; diagnosis; therapy; analysis

Special Issue Information

Dear Colleagues, 

Many orthopedic disorders in children and adults are located in the spine or lower extremities. There is often a connection between these disorders, for instance, a leg length discrepancy and the spine. This issue addresses all aspects of the spine and lower extremities with respect to the orthopedic fields. This includes the spine, the hip, the pelvis and the lower extremity.  Reports on diagnosis, therapy and analysis are welcomed as well as clinical reports on conservative or surgical treatment. Therefore, we invite researchers to contribute to this Special Issue with original research articles, review articles and meta-analyses focusing on the topics mentioned above.

Prof. Dr. Klemens Trieb
Guest Editor

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Keywords

  • spine 
  • hip 
  • pelvis 
  • lower extremity 
  • diagnosis 
  • therapy 
  • analysis

Published Papers (4 papers)

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Research

12 pages, 1261 KiB  
Article
How Does Anxiety and Depression Affect the Outcome after Periradicular Infiltration Therapy?—A Retrospective Analysis of Patients Undergoing CT-Guided Single-Level Nerve Root Infiltration Due to Chronic Monoradicular Pain
by Chris Lindemann, Alexander Hölzl, Sabrina Böhle, Timo Zippelius and Patrick Strube
Diagnostics 2023, 13(18), 2882; https://doi.org/10.3390/diagnostics13182882 - 08 Sep 2023
Viewed by 824
Abstract
The aim of this study was to research the influence of psychological confounders on patient-reported outcomes (PROs) after lumbar infiltration therapies of periradicular infiltrations (PRI). Patients who underwent PRI in a single center between June 2018 and December 2019 were included. PRI was [...] Read more.
The aim of this study was to research the influence of psychological confounders on patient-reported outcomes (PROs) after lumbar infiltration therapies of periradicular infiltrations (PRI). Patients who underwent PRI in a single center between June 2018 and December 2019 were included. PRI was performed in patients with predominantly unilateral lumbar radiculopathy which existed for at least 6 weeks based on single-level nerve root compression (caused by a herniated disc, stenosis of the lateral recess, or neuroforamen), confirmed by morphological imaging. The numeric pain rating scale (NRS) for back pain (BP) and leg pain (LP) and the Oswestry Disability Index (ODI) were assessed preinterventionally, on the first day (only NRS) and at 6 weeks, and then 3, 6, and 12 months postinterventionally. The minimally clinically important difference (MCID) served as the threshold for the therapeutic effectiveness evaluation. The health-related quality of life (SF-36) was recorded preinterventionally and after 12 months. Based on the Hospital Anxiety and Depression Scale, the patients were dichotomized into depressed or nondepressed and anxious or nonanxious. Categorical data were evaluated using Fisher’s exact test, and continuous data were evaluated using Student’s t test. Separate linear mixed models were built to estimate the effect of anxiety or depression on repeatedly measured PROs following PRI. Data were analyzed using SPSS software. The analysis included 102 patients. Most mean baseline PROs were significantly worse in anxious or depressed patients than in nonanxious or nondepressed patients: Anxiety NRS-BP (p = 0.007), ODI (p < 0.001); Depression NRS-BP (p = 0.026), NRS-LP (p < 0.001), ODI (p < 0.001). All patients showed a clinically meaningful reduction in pain and functional improvement over a 12-month follow-up. There was no significant difference in the estimated overall mean PRO between all patients (p > 0.05). In conclusion, anxiety and depression are associated with worse PROs before and after PRI. However, patients with underlying depression or anxiety can expect a similar gain in PRO compared to patients without depressive or anxious symptoms. Full article
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9 pages, 1059 KiB  
Article
Postoperative 30-Day Comparative Complications of Multilevel Anterior Cervical Discectomy and Fusion and Laminoplasty for Cervical Spondylotic Myelopathy: An Evidence in Reaching Consensus
by Ryan Wing-Yuk Chan, Yung-Hsiao Chiang, Hsiu-Chen Lin, Chih-Yau Chang and Yi-Syue Tsou
Diagnostics 2023, 13(12), 2024; https://doi.org/10.3390/diagnostics13122024 - 10 Jun 2023
Viewed by 1118
Abstract
Although a few large-scale studies have investigated multilevel anterior cervical discectomy and fusion (ACDF) and laminoplasty (LAMP) and their related complications for cervical spondylotic myelopathy (CSM), the optimal surgical intervention remains controversial. Therefore, we compared their 30 days of postoperative complications. Through the [...] Read more.
Although a few large-scale studies have investigated multilevel anterior cervical discectomy and fusion (ACDF) and laminoplasty (LAMP) and their related complications for cervical spondylotic myelopathy (CSM), the optimal surgical intervention remains controversial. Therefore, we compared their 30 days of postoperative complications. Through the 2010–2019 ACS NSQIP Participant Use Data Files, we estimated the risk of serious morbidity, reoperation, readmission, mortality, and other postoperative complications. Initially, propensity score matching (PSM) of the preoperative characteristics of both groups was performed for further analysis. Multivariable logistic regression analysis provided OR and 95% CI for comparative complications. After PSM, 621 pairs of cohorts were generated for both groups. Increased frequency of postoperative complications was observed in the LAMP group, especially for surgical wound infection, no matter whether superficial (ACDF/LAMP = 0%/1.13%, p = 0.0154) or deep wound infection (ACDF/LAMP = 0%/0.97%, p = 0.0309). The mean length of total hospital stays (ACDF/LAMP = 2.25/3.11, p < 0.0001) and days from operation to discharge (ACDF/LAMP = 2.12/3.08, p < 0.0001) were longer, while the hospitalization rate for over 30 days (ACDF/LAMP = 4.67%/7.41%, p = 0.0429) and unplanned reoperation (ACDF/LAMP = 6.12%/9.34%, p = 0.0336) were higher in LAMP. Results also indicated congestive heart failure as a risk factor (adjusted OR = 123.402, p = 0.0002). Conclusively, multilevel ACDF may be a safer surgical approach than LAMP for CSM in terms of perioperative morbidities, including surgical wound infection, prolonged hospitalization, and unplanned reoperation. However, these approaches showed no significant differences in systemic complications and perioperative mortality. Full article
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16 pages, 45858 KiB  
Article
Classification of Cervical Spine Fracture and Dislocation Using Refined Pre-Trained Deep Model and Saliency Map
by Soaad M. Naguib, Hanaa M. Hamza, Khalid M. Hosny, Mohammad K. Saleh and Mohamed A. Kassem
Diagnostics 2023, 13(7), 1273; https://doi.org/10.3390/diagnostics13071273 - 28 Mar 2023
Cited by 7 | Viewed by 3462
Abstract
Cervical spine (CS) fractures or dislocations are medical emergencies that may lead to more serious consequences, such as significant functional disability, permanent paralysis, or even death. Therefore, diagnosing CS injuries should be conducted urgently without any delay. This paper proposes an accurate computer-aided-diagnosis [...] Read more.
Cervical spine (CS) fractures or dislocations are medical emergencies that may lead to more serious consequences, such as significant functional disability, permanent paralysis, or even death. Therefore, diagnosing CS injuries should be conducted urgently without any delay. This paper proposes an accurate computer-aided-diagnosis system based on deep learning (AlexNet and GoogleNet) for classifying CS injuries as fractures or dislocations. The proposed system aims to support physicians in diagnosing CS injuries, especially in emergency services. We trained the model on a dataset containing 2009 X-ray images (530 CS dislocation, 772 CS fractures, and 707 normal images). The results show 99.56%, 99.33%, 99.67%, and 99.33% for accuracy, sensitivity, specificity, and precision, respectively. Finally, the saliency map has been used to measure the spatial support of a specific class inside an image. This work targets both research and clinical purposes. The designed software could be installed on the imaging devices where the CS images are captured. Then, the captured CS image is used as an input image where the designed code makes a clinical decision in emergencies. Full article
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10 pages, 2265 KiB  
Article
Finger-Floor Distance Is Not a Valid Parameter for the Assessment of Lumbar Mobility
by Luis Becker, Friederike Schömig, Lea Marie-Sophie Cordes, Georg N. Duda, Matthias Pumberger and Hendrik Schmidt
Diagnostics 2023, 13(4), 638; https://doi.org/10.3390/diagnostics13040638 - 08 Feb 2023
Viewed by 1671
Abstract
Low back pain (LBP) could be associated with a reduced lumbar mobility. For the evaluation of lumbar flexibility, parameters such as finger-floor distance (FFD) are historically established. However, the extent of the correlation of FFD to lumbar flexibility or other involved joint kinematics [...] Read more.
Low back pain (LBP) could be associated with a reduced lumbar mobility. For the evaluation of lumbar flexibility, parameters such as finger-floor distance (FFD) are historically established. However, the extent of the correlation of FFD to lumbar flexibility or other involved joint kinematics such as pelvic motion, as well as the influence of LBP, is not yet known. We conducted a prospective cross-sectional observation study with 523 participants included (167 with LBP > 12 weeks, 356 asymptomatic). LBP-participants were matched for sex, age, height, and body-mass-index with an asymptomatic control cohort, resulting in two cohorts with 120 participants each. The FFD in maximal trunk flexion was measured. The Epionics-SPINE measurement-system was used to evaluate the pelvic and lumbar Range-of-Flexion (RoF), and the correlation of FFD to pelvic- and lumbar-RoF was evaluated. In an asymptomatic sub-cohort of 12 participants, we examined the individual correlation of FFD to pelvic- and lumbar-RoF under gradual trunk flexion. Participants with LBP showed a significantly reduced pelvic-RoF (p < 0.001) and lumbar-RoF (p < 0.001) as well as an increased FFD (p < 0.001) compared to the asymptomatic control cohort. Asymptomatic participants exhibited a weak correlation of FFD to pelvic-RoF and lumbar-RoF (r < 0.500). LBP patients revealed a moderate correlation of FFD to pelvic-RoF (male: p < 0.001, r = −0.653, female: p < 0.001, r = −0.649) and sex-dependent to lumbar-RoF (male: p < 0.001, r = −0.604, female: p = 0.012, r = −0.256). In the sub-cohort of 12 participants, gradual trunk flexion showed a strong correlation of FFD to pelvic-RoF (p < 0.001, r = −0.895) but a moderate correlation to lumbar-RoF (p < 0.001, r = −0.602). The differences in FFD in an individual patient, assuming consistent hip function, may be attributed partially to the differences in lumbar flexibility. However, the absolute values of FFD do not qualify as a measure for lumbar mobility. Rather, using validated non-invasive measurement devices should be considered. Full article
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